Introdução: No parto normal, muitas mulheres têm lacerações perineais espontâneas, mas a prevalência, as características e os fatores relacionados a estas são pouco estudados. Objetivos: 1. Caracterizar as lacerações perineais espontâneas no parto normal; 2. Analisar as lacerações perineais espontâneas no parto normal, conforme as condições sociodemográficas maternas, as condições clínicas e obstétricas na gestação e no parto e as condições do recém-nascido; 3. Avaliar as morbidades perineais relacionadas às lacerações espontâneas até 48 horas após o parto. Método: Estudo transversal, realizado no Amparo Maternal, São Paulo (SP), entre outubro de 2011 e janeiro de 2012. Foram incluídas 100 mulheres com idade 18 anos; gestação a termo; feto único, em apresentação cefálica; parto normal com laceração espontânea. Os desfechos primários foram tipo, localização, grau, forma e tamanho da laceração espontânea, avaliados com a Peri-Rule. As análises descritiva e inferencial foram realizadas por meio dos testes Qui-quadrado, t-Student, ANOVA e correlação de Pearson, com p-valor <0,05 apontado como estatisticamente significante. Resultados: 51% das mulheres tiveram laceração única, 49% lacerações múltiplas; 58% tiveram laceração na região anterior do períneo, 80% na região posterior e 23% na parede vaginal; 77,5% tiveram laceração de 1º grau, 20% de 2º grau e 2,5% de 3º grau (sem rotura completa do esfíncter anal); 62,5% das lacerações eram de forma linear, 35% em forma de U e 2,5% ramificadas; na região anterior, a média da extensão das lacerações foi 28,6mm (±12,9); na região posterior, a média da extensão da mucosa foi 26,1mm (±10,5), a média da extensão da pele foi 24,3mm (±10,4) e a média da profundidade foi 18,1(±8,6). Na parede vaginal, a média da extensão foi 19,8mm (±6,5). Para o cálculo da média do tamanho das lacerações, foi considerado o maior valor para cada mulher. Houve diferença estatisticamente significante em relação às seguintes variáveis: localização (região anterior e posterior do períneo e parede vaginal) e idade materna; grau (primeiro, segundo e terceiro) e realização de exercícios perineais na gestação, edema perineal no parto, tipo de puxo, variedade de posição no desprendimento cefálico e tamanho da circunferência cefálica; forma (linear, U ou ramificada) e exercício perineal na gestação, uso de misoprostol, tipo de puxo, variedade de posição no desprendimento cefálico e circunferência cefálica; tamanho das lacerações na região posterior do períneo (extensão na pele) e edema perineal, altura do períneo e uso de ocitocina; tamanho das lacerações na região anterior do períneo (extensão da mucosa) e idade materna, uso de misosprostol e peso do recém-nascido; extensão parede vaginal e edema perineal. Não houve diferença estatisticamente significante em relação ao tipo de laceração (única ou múltipla). As principais morbidades perineais no pós-parto foram ardência, edema, hematoma, equimose e dor. Conclusão: A região posterior do períneo foi a mais afetada e as médias do tamanho das lacerações variaram de acordo com o local atingido. A ocorrência de lacerações de terceiro grau e a frequência de lacerações na parede vaginal indicam a importância da avaliação criteriosa do esfíncter anal, assim como do canal de parto, mesmo quando não há solução de continuidade aparente na região perineal. / Introduction: Most vaginal delivery are accompanied by spontaneous perineal lacerations. However there is a lack of knowledge related to prevalence, characteristics and risk factors of these lacerations in the literature. Aims: 1. To characterize the spontaneous lacerations in normal birth; 2. To analyze the spontaneous perineal lacerations in normal birth, according to socio-demographic, clinical and obstetric conditions during pregnancy and childbirth and the conditions of the newborn; 3. To evaluate morbidities related to spontaneous perineal lacerations until 48 hours after delivery. Methods: A cross-sectional study was carried out in Amparo Maternal maternity unit, São Paulo, BR. The data was collected from October, 2011 to January, 2012. There were included 100 women aged 18 years; fullterm pregnancy; single live fetus and vertex presentation; normal birth with spontaneous laceration. The primary outcomes were type, area, degree, shape and size of spontaneous lacerations, using the Peri-Rule. Descriptive and inferential analyzes were appraised using the chi- square test, Student\'s t-test, ANOVA and Pearsons correlation, with p-value<0.05 indicated as statistically significant. Results: 51% of women had single laceration and 49% multiple ones; 58% had anterior perineum lacerations, 80% in the posterior area and 23% in the vaginal wall; 77.5% had 1st degree, 20% 2nd degree and 2.5% 3rd degree lacerations (without complete rupture of the anal sphincter); 62.5% of lacerations were linear, 35% were \"U\" shape and 2.5% star shape. The average length of lacerations was 28.6 mm (sd ± 12.9) in the anterior area; the average length of the mucosa in the posterior area was 26.1 mm (sd ± 10.5), the length of skin was 24.3 mm (sd ± 10 4) and the depth was 18.1 (± 8.6); the average length of the vaginal wall was 19.8 mm (sd ± 6.5). In order to calculate the average size of lacerations, the highest value for each woman was considered. There were significant differences for the following variables: area (anterior and posterior perineum area and vaginal wall) and maternal age; degree (first, second and third) and perineal exercises during pregnancy, presence of perineal edema during labor, type of pushing, fetal position variety and size of head circumference; shape (linear, \"U\" or star) and perineal exercise during pregnancy, use of misoprostol, type of pushing, head delivery position and head circumference; size of lacerations in the posterior perineum area (skin length) and perineal edema, perineum height and use of oxytocin; size of lacerations in the anterior perineum area (mucosa length) and maternal age, use of misoprostol and weight of the newborn; length of the laceration on vaginal wall and perineal edema. There was no statistically significant difference in the type of laceration (single or multiple). Major postpartum perineal morbidities were blazing, edema, hematoma, ecchymosis and pain. Conclusion: The posterior perineum area was the most affected and the average size of lacerations varied according to the affected area. The occurrence of third degree lacerations and the frequency of lacerations in the vaginal wall indicate the importance of careful evaluation of the anal sphincter, as well as the birth canal, even if when the is no apparent solution of continuity in the perineum.

Apesar dos esforços a favor da humanização do nascimento, sabemos que ainda se fazem presentes na prática uma série de procedimentos intervencionistas no trabalho de parto e parto que interferem nesse processo. Assim, a depender de como se dá o processo de parturição, este acarretará nas condições maternas e neonatais para o início do aleitamento materno, e como consequência, no processo da amamentação, uma vez que a mulher deve ser o elemento chave para esta prática. A prontidão do recém-nascido (RN) para mamar, depende do seu estado de consciência, sendo que pode apresentar-se mais sonolento em situações que envolvem o uso de anestésicos ou outras intervenções em suas mães durante o trabalho de parto. O objetivo do presente estudo é identificar a relação entre a prontidão do RN para sugar a mama materna na primeira mamada no alojamento conjunto e a condução do trabalho de parto, parto e nascimento. Trata-se de um estudo observacional, transversal, descritivo exploratório, realizado com 43 binômios, com RN de idade gestacional entre 37 e 41 semanas e 6 dias, Apgar >= 7 no 5º minuto, filhos de mães primíparas. O projeto foi aprovado pelo Comitê de Ética em Pesquisa da Escola de Enfermagem de Ribeirão Preto da Universidade de São Paulo, com protocolo (Nº1219/2010). As informações do processo de nascimento foram coletadas dos prontuários, e a partir das entrevistas às puérperas. A avaliação da prontidão dos RN para sugarem, foi feita por meio de filmagens dos neonatos desde o início ao término da primeira mamada no alojamento conjunto, sendo avaliados os estados de sono e vigília e mamada, com base no Formulário de Observação da mamada da OMS (1997). De acordo com o formulário os itens foram categorizados como \"sinais positivos\" e \"sinais negativos\", relacionados às condições favoráveis e às dificuldades na mamada. A análise foi fundamentada na estatística descritiva e na realização de testes estatísticos para análise comparativa entre as variáveis. Quanto aos resultados, em sala de parto, 17 (39,5%) neonatos foram colocados em contato pele imediato e apenas 4 (9,3%) sugaram o seio materno. Das 43 parturientes, 39 (90,7%) receberem analgesia, porém apenas 14 (32,6%) receberam a segunda analgesia (repique). No momento em que as mesmas receberam a primeira analgesia, a dilatação cervical variou entre 2 e 9 cm, sendo que 13 (33,3%) estavam com 5 cm. No repique, a dilatação cervical variou entre 4 e 10 cm, sendo que 6 (42,9%) estavam com 8 cm. O período mínimo de duração do trabalho de parto, foi de 25 minutos, e o tempo máximo, 11 horas. A menor duração do período expulsivo foi de 1 minuto e o tempo máximo, 59 minutos. Quanto aos dados referentes ao puerpério imediato, 36 (83,7%) mães referiram que estavam com sono logo após o parto e apenas 9 (20,9%) delas relataram estar sentindo algum tipo de dor e quanto ao cansaço, a maioria 41 (95,3%) referiu estar cansada. O período sem ingerir líquido variou de 33 minutos a 22h e 35 min e o período em jejum alimentar variou entre 2h 50 min e 21h 05 min. Em relação ao estado de sono e vigília no período que antecedeu a mamada, 18 (41,9%) dos recém nascidos estiveram no estado alerta quieto. Durante a mamada em 21(48,8%) dos neonatos, o estado sono ativo foi predominante. Na avaliação da mamada, os índices positivos se fizeram presentes nos diferentes domínios avaliados: 86,1% na sucção, 85,6% na postura corporal, 82,3% nas respostas do RN, 100% na anatomia da mama, no 78,4% tempo gasto na sucção durante a mamada. Quanto às associações entre as variáveis do trabalho de parto, parto e nascimento e as da mamada, obteve-se dados significativos entre a duração do período expulsivo e grupo sono e sonolento de estado de sono e vigília, com p=0,03. Embora as mães tivessem recebido intervenções durante o trabalho de parto e parto que pudessem interferir na qualidade da primeira mamada em alojamento conjunto, a maioria dos neonatos apresentou-se em estado de alerta, isto foi o suficiente para que eles apresentassem boa prontidão para mamar neste momento. O alojamento conjunto precoce, se mostrou uma prática favorável para a obtenção de sinais positivos na avaliação da primeira mamada à admissão de ambos. / Despite efforts to promote the humanization of birth, we know that still present in practice a number of interventional procedures during labor and childbirth that interfere with this process. So, depending on how is the parturition process, this will result in maternal and neonatal conditions for the initiation of breastfeeding, and as consequence, in the process of breastfeeding, since the woman should be the key element to this practice. The readiness of the newborn (NB) to nurse, depends on your state of consciousness, and may present more drowsy in situations involving the use of anesthetics or other interventions in their mothers during labor. The aim of this study is to identify the relationship between NB readiness to suck the maternal breast in the first feeding on the rooming in and conduct of labor, and birth. This is an observational, cross-sectional, descriptive and exploratory, conducted with 43 binomials, with NB in the gestational age between 37 and 41 weeks and 6 days, Apgar score >= 7 in the fifth minute, the children of first-time mothers. The project was approved by the Research Ethics Committee of the Nursing School of Ribeirão Preto, University of São Paulo, with protocol (No. 1219/2010). Information from the birth process was collected from medical records and from interviews with puerperal. The assessment of the NB readiness to suck, was made by filming the neonates from the beginning to the end of the first feeding in rooming in, evaluated the states of sleep and wakefulness and feeding, based on Observation of breastfeeding from WHO (1997). According to the form of the items were categorized as \"positive signals\" and \"negative signals\", related to the favorable conditions and difficulties in feeding. The analysis was based on descriptive statistics and statistical tests for comparative analysis between the variables. As for the results in the delivery room, 17 (39.5%) neonates were placed in immediate contact skin and only 4 (9,3%) sucked the breast. Of the 43 pregnant women, 39 (90.7%) received analgesia, but only 14 (32.6%) received the second analgesia (reinjection). At the moment in which they receive a first analgesia, cervical dilation varied between 2 and 9 cm, while 13 (33.3%) had 5 cm. In reinjection, cervical dilation varied between 4 and 10 cm, and 6 (42.9%) had 8 cm. The minimum duration of labor was 25 minutes and the maximum period 11 hours. The lowest delivery duration was 1 minute and the maximum time, 59 minutes. As for the data relating to postpartum, 36 (83.7%) mothers reported that they were sleepy soon after birth and only 9 (20.9%) of them reported to be feeling some sort of pain and tiredness, the most 41 (95.3%) reported being tired. The period without ingesting fluid ranged from 33 minutes to 22h and 35 min and fasting period varied between 50 min and 21h 2h 05 min. Regarding the state of sleep and wakefulness in the run-feeding, 18 (41.9%) of the infants were in quiet alert state. While feeding in 21 (48.8%) of the neonates, the active sleep state was predominant. In the assessment of breastfeeding, positive indices were present in different areas evaluated: 86.1% in sucking, 85.6% in body posture, 82.3% of infants\' responses, 100% in the anatomy of the breast, 78, 4% time spent sucking during breastfeeding. Regarding the associations between the variables of labor, and birth and breastfeeding, significant data was obtained from the delivery duration and sleep group and sleepy state of sleep and wakefulness, with p = 0.03. Although mothers had received interventions during labor and delivery that could interfere with the quality of the first feeding in rooming in, most neonates presented on alert, that was enough for them to present good readiness to nurse this time. The early rooming in practice proved favorable for obtaining positive signals in the evaluation of the first feed intake both.

Introdução: As influências lunares e ambientais no início do trabalho de parto ainda são pouco estudadas. Foi avaliada a influência extrínseca em eventos obstétricos. Métodos: em um hospital secundário, situado na cidade de São Paulo, Brasil, foram selecionados 1.826 dias em que ocorreram 17.417 partos. As internações por o trabalho de parto foram associadas à temperatura ambiental, pressão atmosférica, variação das marés e das fases lunares na incidência do excesso deste evento, pelo percentil 75. O índice Z (desvio padrão/ pela média) de cada variável foi calculado e a diferença diária indicou o aumento ou a diminuição. Foi utilizada a análise de regressão logística para a predição do excesso da admissão e p<0,05 foi considerado significativo. Resultados: Os preditores do excesso da internação por trabalho de parto foram: o aumento da temperatura (risco relativo: 1,742, p=0,045) e diminuição da pressão atmosférica (risco relativo: 1,269, p=0,029). O aumento da amplitude das marés foi associado com a probabilidade menor do excesso da internação (risco relativo: 0,762, p=0,030). A fase lunar não era preditora do excesso da admissão (p=0,339). Conclusão: Pela análise multivariada, o aumento da temperatura e a diminuição da pressão atmosférica predisseram a ocorrência do excesso da admissão por trabalho de parto e o aumento da amplitude das marés, como uma medida da força gravitacional lunar, foi preditora de uma menor probabilidade do excesso do trabalho de parto / Background: lunar and environmental influences in vaginal delivery remain unclear. We assessed extrinsic influence in obstetric events. Methods: in a secondary line hospital, located in São Paulo city, Brazil, we selected 1,826 days, in which occurred 17,417 admissions for obstetric labor, and we studied influence of air temperature, atmospheric pressure, tides range, and lunar phases in incidence of excess of obstetric labor, defined as more than 9 admissions per day. Z score (standard deviation from mean) of each variable was calculated, and diary difference to indicate increase or decrease was assessed by logistic regression for prediction of admission excess. Two-side P< 0.05 was considered significant. Results: predictors of admission excess were increase of temperature (relative risk: 1.742, P=0.045), and decrease of atmospheric pressure (relative risk: 1.269, p=0.029). Increase of tides range was associated with lower probability of admission excess (relative risk: 0.762, P=0.030). Lunar phases was not predictor of admission excess (P=0,339). Conclusion: By multivariate analysis, increase of temperature and decrease of atmospheric pressure predicted occurrence of excess of obstetric labor admission, and increase of tidal range, as lunar gravitational force measurement, predicted lower probability of admission excess

Background: Historically, the focus of the UK and international research exploring planned home birth decision making has been largely focused on understanding the experiences of women who decide to birth at home. As a result of high-profile research that suggests that non-OU birth locations are safe for low risk women, there has been a recent shift in focus resulting in research studies that aim to increase the rates of planned home birth, or more often the rates of all non-obstetric unit birth within the UK. However, despite this increased level of attention, the rate of home birth remains stubbornly low. Whilst there is some research to indicate why this might be the case, research that sheds a new light on the issue, and that develops an evidence base for new interventions is required. This thesis illuminates the factors that need to be considered in order to increase women’s abilities to make an informed decision about planned birth. Methodology: A pragmatic approach, using mixed methods, was used to explore the current way that we offer planned home birth to maternity service users, and to ultimately make suggestions about how this could be improved. The following studies have been undertaken: Study 1: Initial exploratory study: The case notes of one hundred and sixty nine women, from one health board and who had planned to birth at home, were audited. Non-participant observation of birth planning meetings at thirty-six weeks gestation were undertaken with seven community midwife and low-risk women dyads. These were followed by individual semi-structured interviews with the participants. Study 2: Scoping review: Qualitative and quantitative research, and non-research based literature, were analysed to produce a qualitative review of planned home birth decision making. Study 3: Active offer of planned home birth concept analysis The findings of the initial exploratory study and the scoping review, in addition to active offer literature that is predominantly applied to support the provision of services within minority official languages, were used to create an active offer of planned home birth. Study 4: Workshop study testing the findings of the concept analysis Narrative based exercises were used to explore the concept analysis findings with twenty previous service users who had birthed at home, nine previous service users who had chosen an institutional birth, and fourteen community midwives. Findings: Women will either take a ‘passive’ or ‘active’ approach to the offer of planned home birth, with a passive approach likely where no motivation for an active approach has been provided. Where a woman takes a passive approach, her ability to make an informed decision about planned home birth will depend on an active offer being made by her midwife. This will be most effective when it is supported by a midwife’s employing organisation. The findings of this thesis suggest that a two stage active offer of planned home birth (AOPHB) process, consisting of ‘Creating the conditions’ and ‘Positive reinforcement’ stages, can be used to underpin the offer of planned home birth. Discussion: There has previously been minimal understanding of how to facilitate the home birth decision making process, and a passive offer is routinely provided to women in the UK. The proposed two-stage AOPHB process provides a structured way for midwives to underpin their offer to women, in order that an increased percentage of women are able to make an informed decision about home birth and/or decide to birth at home. Where midwives apply the AOPHB, women who may take a passive approach could be ‘activated’ to engage in home birth decision making. A pilot intervention has been drafted to implement the AOPHB within clinical practice. The intervention provides support for the implementation of the two-stage AOPHB process through the use of individual components focused on midwives and their employing organisation; student midwives; and women, and their significant others. Implications: This thesis has contributed to the developing knowledge base about planned home birth decision making. The application of active offer theory to the offer of planned home birth has been undertaken for the first time, and this has generated a new and useful perspective on this area of midwifery practice. The resultant two-stage AOPHB process has the potential for developing midwifery practice in terms of supporting midwives to understand and facilitate women’s decision making around home birth, providing a flexible tool that can be used in clinical practice. This is the first approach that has been developed with the aim of increasing the ability of women to make an informed decision about whether they wish to birth at home. Additionally, the pilot AOPHB intervention has implications around the understanding of how employing organisations can best support midwives in this aspect of their role, and developing how student midwives are educated about offering home birth to women.

Thesis. 1979. M.Arch.--Massachusetts Institute of Technology. Dept. of Architecture. / MICROFICHE COPY AVAILABLE IN ARCHIVES AND ROTCH. / Bibliography: leaves 89-92. / M.Arch.

Thesis (M.S.)--Boston University / PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. / 2031-01-01

Thesis (M.C.P.)--Massachusetts Institute of Technology, Dept. of Urban Studies and Planning, 1980. / MICROFICHE COPY AVAILABLE IN ARCHIVES AND ROTCH. / Vita. / Bibliography: leaves 134-138. / by Naomi A. Pless. / M.C.P.

Blood Riveris an exploration of lineage and blood connection as families are made and remade over generations. The poems rise from the physical body, from birth, and again from death. The lyric is used as a mode of investigation as she writes to discover what it means to become a mother, what it means to be a daughter and wife, and finally what it means to remake the self in order to embody all that we are. The poems are born from the heart and explore the connections between us all.

Unassisted childbirth--giving birth at home without a midwife or physician present--emerged as a movement in mid-20th century North America. While only a small number of women choose to give birth unassisted, its significance extends far beyond its numbers. Unassisted birth illuminates trends in maternity care practices that drive, and sometimes force, women to choose unassisted birth. It also is part of a larger set of connected values and lifestyle choices, including home schooling, breastfeeding, co-sleeping, ecological awareness, cloth diapering, sustainable living, and alternative medicine. Finally, the emergence of UC as a conscious birth choice requires a re-examination of how we understand, frame, and interpret childbirth paradigms. There is very little written about unassisted birth in the academic world, although media reports on the practice have become increasingly prevalent since 2007. This dissertation begins the conversation for a scholarly inquiry into unassisted birth. My research is based primarily on interviews, essay-response surveys, and archives of internet discussion groups. After setting unassisted birth in historical context, I explain why women make this choice; the knowledge sources they privilege; how they understand the concepts of safety, risk, and responsibility, and their complex and sometimes contradictory relationship with midwifery. I also examine midwifery, and to a smaller degree, obstetrical, perspectives on unassisted birth, focusing on how birth attendants who are sympathetic to UC reconcile that with their training and experience attending births. Unassisted birth has changed the core questions we need to ask about birth. Instead of home or hospital?, natural or epidural?, or midwife or obstetrician?, questions asked by existing models of childbirth, unassisted birth poses a different set of core questions: Is birth disturbed or undisturbed? Is it social or intimate? managed or intuitive? attended or unattended?

The use of mainstream maternity services by urban Aboriginal women is an important issue for health professionals. Aboriginal mothers are much more likely to die in childbirth than are non-Aboriginal mothers and their excessive risk does not appear to have changed over the last two decades. The infant mortality rate is three times higher than for non-Aboriginal infants. Therefore, this project aimed to discover the cultural needs of urban Aboriginal women who use mainstream maternity services. Six Aboriginal women who were attending the ante-natal clinic at Daruk Aboriginal Medical Service were interviewed. The thesis included the following recommendations and strategies for their implementation: 1/. Establishment of a discrete Aboriginal women's health unit in Western Sydney. 2/. Provision of culturally acceptable education about pregnancy and childbirth. 3/. Promotion of breastfeeding. 4/. Education and encouragement for non- Aboriginal health professionals. / Master of Nursing (Hons)